Suicide: An EMS epidemic

At the 2016 Pinnacle Conference, the results of a mental health survey were reported. The survey revealed that an astounding 37% of the respondents contemplated suicide. The national average is 3.7%. An astounding 6.6% of respondents attempted suicide. The national average is 0.05%.

This is another “S” word that apparently makes some uncomfortable. It’s a word that we need to hear, speak and recognize functionally. The National Fallen Firefighters Foundation has a Behavioral Health Initiative (FLSI 13) that addresses surveillance, prevention, and intervention measures for suicide. As part of the initiative, Dr. Richard Gist et alia have written a “White Paper” which is full of great information. The CDC, American Psychiatric Association and the American Association of Suicidology, and the American Foundation for Suicide Prevention all offer great information at their websites. It’s somewhat surprising that with all of the educated, intelligent people addressing this issue, mental health professionals bemoan the inconsistent application of definitions, and difficulties in validating statistics.  I was on a conference call recently in which EMS professionals clamored for EMS specific suicide statistics. What would that accomplish? 

Using the arguably best data available from the CDC we know that in 2009, suicide was the tenth leading cause of death for people 10 years of age and older. More people died from suicide than from any of the following: septicemia, liver disease, hypertension, Parkinson’s Disease, Homicide, Pneumonitis, Benign Neoplasms, Aortic Aneurysm, HIV, or Viral Hepatitis.

Suicide facts from the CDC

• Males represent 78.8% of all U.S. Suicides
• Males kill themselves four times the rate of females
• Overall suicide is the seventh leading cause of death for males and the fifteenth leading cause for females
• Suicide is the second leading cause of death among 25-34 year olds and the third leading cause of death among 15 to 24 year olds
• The National Violent Death Reporting System found that in 16 states those who died by suicide were tested for substances, one in three were positive for alcohol and one in five had evidence of opiates
• In 2007 there were 37,000 suicides in the US, which is about 94 a day, one every 15 minutes or 11.26 per 100,000 population.

PTSD statistics from the Substance Abuse and Mental Health Services Administration

The SAMHSA (Substance Abuse and Mental Health Services Administration) blog has some frightening Post Traumatic Stress Disorder (PTSD) occurrence statistics.

• 11-20% of Iraq and Afghanistan Veterans
• 10% of Gulf War Veterans
• 30% of Vietnam Veterans
• 7-8% of the general population will experience PTSD at some point in their lives
• 5.2 million adults have PTSD during a given year
• About 10% of women and 5% of men will develop PTSD
• It is estimated that 10%-30% of EMS practitioners experience PTSD

Do we need to be statisticians or mini-pseudo for mental health professionals to address stress, PTSD or suicide? If you think we do, let’s add depression to the mix. There are great resources available from local Licensed Mental Health Professionals and via the aforementioned web-sites. Training, consultations and posters are available. 

We’re not Mental Health Professionals, but if we adhere to the concepts of the culture of safety, crew resource management, and just culture in conjunction with appropriate interaction with licensed mental health professionals might we not reduce occupational risk factors that affect risk of suicide?

The white paper I mentioned lists three essential conditions involved with suicide. Briefly, they are

• Thwarted belongingness: alone, unconnected, meaningless
• Perceived burdensomeness: drain on family, friends, co-workers, world better without me
• Capability: experience and disposition overcomes aversion to pain or death

Other Potential Warning Signs are substance abuse, hopelessness, purposelessness, anger, recklessness, feeling trapped, social withdrawal, anxiety, mood changes, sleep disturbances, and guilt or shame.

If we can truly communicate in an environment with peers who earn each other’s trust by celebrating victories, sharing defeats, and never expecting more from another than they expect from themselves, maybe we can more readily stay connected, know we’re not a burden, and never find pain or death acceptable. Suicide should not be the “S” in EMS. 

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References:

Gist R, Taylor VH, Raak S. White paper: suicide surveillance, prevention and intervention measures for the US Fire Service Presented at: The Suicide and Depression Summit hosted by the National Fallen Firefighter Foundation. July 11 to 12, 2011, Baltimore, Maryland. 

Marshall, J. Beyond Suicide Prevention: Building Caregiver Resilience Presented at: The Pinnacle Conference, Hosted by Fitch and Associates, July 20, 2016, San Antonio, Texas.